Mental Patients Face Longer Hospital Stays

John is ready to leave Northeast Florida State Hospital, but a program intended to help patients live in the community can't pay him money to help cover room and board at a group home.

As a result, officials have started legal action to have John committed to the mental hospital in Macclenny for another six months.

The problem lies with new rules restricting the optional state supplemental program, which provides monthly housing subsidies for more than 5,000 mentally ill and elderly people statewide.

Mental health workers say John and hundreds of other people in need of help will be kept in state institutions, or worse, end up on the street.

''This defeats our efforts at keeping people out of state hospitals,'' said Baldwin Bunkley, executive director of the Florida Council for Community Mental Health, a non-profit agency in Tallahassee.

''Legislators have to support programs such as this,'' Bunkley said, if the idea of helping patients live in the community is going to work.

''I just don't know what's going to happen. I just can't believe this,'' said Mary Ellen Fay, who works with Mental Health Services of Orange County and the state hospital to help discharge patients.

Lawmakers agreed this year to restrict the program, which had been open to any elderly or disabled person in need and on Social Security's Supplemental Security Income.

Checks averaging $120 a month are given to residents of a licensed group home or adult foster home.

Now a review committee in each district will determine who most needs the money. Eligibility will be based on whether the person is in immediate danger of abuse, neglect or being put into a hospital.

State hospital patients will be at the bottom of the list because, one HRS official said, ''They have a roof over their heads and are not in any immediate danger.''

What bothered legislators about the program were the annual requests for more money to shore it up, said Chuck Daly, acting director of Health and Rehabilitative Services' Economic Services.

Last year a $2 million budget amendment was required and a total of $10.6 million was spent on 5,100 clients statewide, Daly said. This year $11.5 million was appropriated, enough to add 285 clients.

Daly said that at least 200 more people are expected to need the money and be turned away.

Fay said John, not his real name, is eager to leave the hospital but realizes he cannot live on his own. There are places for him in group homes in Orlando.

None will take him without the extra check to pay the difference between room and board costs and his Social Security benefits.

The situation in Brevard, Orange, Osceola and Seminole counties is particularly critical because there already are more people receiving the checks than the state will pay for this year.

According to DeElda Cotamche with the Orlando HRS office, 50 clients were receiving subsidies to live in adult foster homes and 222 were getting the extra money to live in group homes. Most of the people were elderly.

The state said it will pay for 35 people in foster homes and 203 in congregate homes this year.

Cotamche said the state will have to delay further placements

until clients stop receiving checks for such reasons as moving, returning to a hospital or going to live with family.

She said it will mean that people will stay in state hospitals or the elderly who cannot live alone ''will end up in nursing homes.''

The old method of allocating the optional state supplemental checks ''gave us a lot more flexibility. This cap will be a problem,'' Daly said.

Others who work with the mentally ill and elderly say the problem will worsen as the state grows and more emphasis is put on keeping people out of institutions.

They say gridlock in the mental health system, waiting lists for people to get in the hospital and to get out, will worsen and local agencies will explode with clients needing a place to go.

''This is going to put a lot of people in a bind,'' said Connie Stolp, a case management supervisor with Mental Health Services of Orange County. Stolp said it will mean more people will be put in hospitals and thus more work for ''people like us.''

Stolp works with formerly hospitalized patients to place them in group homes and community treatment programs.

She said there is no shortage of homes, but that people who run them are unwilling to take new clients who receive only Social Security or Supplemental Security Income checks, which average $350 a month.

Jean Strada, who cares for five residents in her Pine Hills home near Orlando, four of whom are mentally ill, said it takes at least $486 a month -- the amount the state allows per resident -- to maintain the home and make a living.

The new limit also will affect the HRS recruitment of new foster and adult congregate home operators, who are always needed, said Barbara Wavell in the adult foster home licensing program in Orlando.

Of the three clients that adult foster home managers can take, at least one has to be a state-paid resident, Wavell said. If managers cannot fulfill their obligation with the state to keep their license, they may quit the business.

Stolp said there is no other source of funding to make up for the optional state supplemental money. ''We talked with Orange County Social Services and they said it's possible to give us money through October.''

But, she said, ''We need money on an ongoing basis.''

Clients who already are receiving the extra money will not be affected, unless they leave their foster or congregate home for hospitalization or some other reason, Stolp said.

''This is not only frustrating, but it's really heartbreaking,'' Fay said. ''Many of these people can't work and they depend on us totally.''